Snuff-box versus distal forearm for trans-radial access: performance and radial patency

Introduction: Distal right radial approach (dRRA) in anatomical snuff-box might reduce the probability of radial artery occlusion (RAO) in distal forearm. Furthermore, it allows more comfortable hand position, particularly in obese patients.
Objective: To evaluate dRRA compared to conventi-onal right radial approach (cRRA) in patients treated trans-radially.
Methods: Prospective, single-center, randomised, open label study. Primary end-point was RAO in fo-rearm evaluated on discharge by ultrasonography, whi-le secondary endpoints included procedural success, fluoroscopy time, and homeostasis time. 114 eligible patients were randomised 1:1 into dRRA and cRRA groups. Overall mean age was 63.42 years, 58% were males and PCI was performed in 32% of patients. Both groups had similar clinical and angiographic charac-teristics. 6F sheath and standard catheters were used, homeostasis device was verified after 1 hour then on 30-minutes\’ interval in all patients.
Results: No patient in dRRA group had RAO in fo-rearm versus 3 patients in cRRA group (0% vs. 6%, p<0.01). Procedural success and fluoroscopy time were similar in both groups, however time needed for he-mostasis was significantly lower in dRRA group than cRRA group (83.52 vs. 139.8 minutes, p=0.021). Nei-ther patient suffered forearm ischemia or change in right-hand function.
Conclusions: Radial puncture in anatomical snuff-box is feasible, with promising results regarding radial pa-tency and homeostasis compared to traditional access.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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